Editorial: Politics and breast cancer

Staff Writer
Mount Shasta Herald

The new guidelines on breast cancer screening released last week say a lot about the tough choices physicians and patients must make when it comes to preventive care, and about the role of science in informing those decisions. The reaction to the recommendations says a lot about how politicized everything about health care has become.

The federal advisory panel issuing the recommendations found that the benefits of routine mammograms for women in their 40s -- saving one life for every 1,904 women screened for 10 years -- were outweighed by the potential for unnecessary tests and treatment, and the accompanying anxiety. Women with risk factors for breast cancer, and all women older than 50, should continue to have routine screening.

The outraged reaction from some quarters to the guidelines expresses an attitude that lies at the heart of our health care dilemma: We want everything. If there's a one-in-a-million chance that this test or that treatment will save a life, we expect it. And most of us don't even want to hear about the cost, let alone pay it out of pocket.

In other areas, Americans handle risk more rationally. We understand that there would be fewer highway fatalities if speed limits were reduced to, say, 30 mph, but we accept higher risk in exchange for getting from here to there in less time.

When it comes to our health, or the health of our loved ones, we prefer to avoid weighing risks and rewards. We don't like to take chances. We expect the best modern medicine can offer. We'd rather let the physicians decide. Physicians, in turn, generally err on the side of more tests and more treatments, whether out of fear they may be sued, or because the more treatments and tests they order, the more money they make.

But scientific data informs medical decisions, even in this area. The current breast cancer guidelines don't recommend routine mammograms for women in their 20s or 30s. It's not that women younger than 40 don't get breast cancer, just that all preventive measures must take into account the cost -- in money, inconvenience and the problems that come from "false positives" -- as well as benefits.

It didn't take long for opponents of health care reform to find the specter of "rationing" in the breast cancer recommendations. With information like this, they warned, a "government-run" health care system would "ration" mammography. But millions of women without health insurance are already having routine mammograms denied them, as are millions who have policies that make such tests unavailable or unaffordable.

Politicians of all stripes have been guilty of dictating health coverage. Many states require insurers to cover preventive mammography, and, given the reaction to these recommendations, we expect Congress will be tempted to write the old guidelines into law. Republicans, while condemning government "bureaucrats" dictating what medical procedures should be covered by private insurers, are trying to prohibit private insurers from covering abortion.

Ultimately, decisions on whether a woman should have a mammogram should be made by the patient and her physician, not by the government or an insurance company. The goal of health reform should be, first, to make sure every woman has access to a physician and whatever tests he or she recommends and, second, to provide them with the best available information on the effectiveness of tests and procedures.

The recommendations of health experts are always changing and sometimes wrong. A spike in breast cancer in the '90s has been blamed, in part, on a recommendation that menopausal women have estrogen replacement therapy. That advice has now been withdrawn. If this latest report is to be withdrawn, we hope it will be because of better data, not political pressure.

Breast cancer can kill, especially if it isn't caught early. But data on the effectiveness of various procedures can only help patients and physicians make better decisions.

The MetroWest Daily News